Photo by Stephen Slade Tien
Photo by Stephen Slade Tien

The mental health therapy industry is imposing enough for most people. If you’re an Asian immigrant or Asian-American or Pacific Islander, the cultural aspect may make it even more challenging to find a good therapeutic fit.

Here are some tips for APIs navigating the mental health system.

Because immigrants come from a different culture, worldview, and way of understanding relationships, my first recommendation for them is to find a therapist who can speak your native tongue. Therapy works best when the client can trust the therapist and oftentimes for ethnic clients, it comes down to understanding the language, customs, and culture.

In seeking therapist, it is important to understand who will be the client. Are you seeking help or are you seeking help for your family (i.e. spouse, child, or other relative)? This is significant because the goals of therapy vary depending on who is the one getting treatment. For example, an immigrant Chinese father who seeks me out for help with a suicidal son must understand the son will be the client. Once the immediate crisis is addressed, other issues that the father or mother want worked on (i.e. trying to get the son be more obedient at home, following the parents’ expectations, etc.) may or may not be of my concern depending on what the child wants explored.

Other aspects to consider that could impact the success of therapy are the individual characteristics of the therapist. Is the family more comfortable with a male therapist or a female therapist? Do you want a younger therapist or an older therapist? What about spiritual alignment? Do you feel it’s necessary for the therapist to share similar views on religion? Because therapy works with trust, these issues need to be thought through to see if they are important enough to be considered in the decision-making process.

When it comes to more Americanized Asians (i.e. second generation and beyond), I think cultural competency is still important. You will want a therapist who you feel can understand the cultural challenges you’re going through or faced in childhood. For example, my own therapist is Korean-American. Even though I am Chinese, he understands Asian families enough to grasp the challenges of growing up with immigrant parents that I felt comfortable choosing him for my individual work when compared to a Caucasian therapist who might not have the training, understanding, or experience to ask what about an Asian person’s background (i.e. ethnicity, generational identity in the United States, issues of acculturation, etc.).

Specialties are also important considerations when choosing a counselor. I specialize in addictions, trauma, and Asian-American issues related to autonomy, choice, and relationships. What that typically means is, the focus is in helping Asian-American clients to recognize and find their “voice” and to be able to draw healthier boundaries with their loved ones. One common example is family loyalty. Some Asian-American clients are guilt and/or shame-bound by their family of origin that they must keep their wishes and goals secondary to the family. It could be as seemingly trivial as helping an adult Asian-American client limit their daily interactions with their parents to validating the shame and ostracism he/she is feeling by dating or marrying outside their ethnicity.

In any case, in choosing a therapist you need to find a therapist who can validate and support your goals.

I’ve heard of harmful experiences where Asian-American clients have seen an immigrant Asian therapist who has similar worldviews as their parents only to leave the sessions shamed for their individuality. They were told to just “listen and obey their parents,” thus perpetuating the cycle of shame and dependency that started the therapy in the first place.

Finally, I should note that psychiatrists and ARNP’s (advanced registered nurse practitioners) are able to prescribe medication. Psychologists, and all the master’s level therapists such as LMFT (licensed marriage and family therapist), LMHC (licensed mental health counselor), or LICSW (licensed independent clinical social workers) are not allowed to do so.

However, as therapists, we can give referrals to providers so clients can get a medication prescription. But those decisions are on a case-by-case basis and are not taken lightly. Since I prefer the most conservative approach first, I usually ask (even if they want medication) for a minimum of six months of non-medicated treatment. This might also include adjunct services such as acupuncture or massage for symptom relief.

Helping a client out through therapy can consist of individual, couples, family, or group psychotherapy. In my practice, as much as clients prefer individual therapy, my own bias is augmenting individual therapy with group therapy where issues of shame, assertiveness, and other negative feelings such as the fear of being judged, rejected, or criticized can be addressed directly “in session.” I’ve learned through practice that groups can be one of the most healing aspects of therapy that’s not only cost-effective (usually $50-$70 for up to two hours) but also efficacious because the issues are not only talked about but they are experienced in the group.

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